Dr. Walmart to Aisle 3

I have written often of the ability to eventually replace the standard doctor-patient interaction with technology. But things are changing even faster, due to market forces within the American healthcare system. And there is a real chance that such changes will set the ideal stage for human/technology based healthcare.

Please note that I have no association of any form with Walmart. I admire their obsessive focus on the “little things” that end up saving Walmart millions and millions of dollars. Walmart is known for being a master of inventory management so much so that there is minimal waste of resources secondary to “dead” inventory in warehouses. Business practices like this make Walmart extremely formidable.

Walmart is an extremely powerful force in the marketplace for day-to-day goods. It is typically not thought of as a place where one can expect to get a medical opinion, vs. just a refill on a prescription. Walmart is also very well known for low cost products. These products are not less in quality than you will find in other stores. The business magic of Walmart allows it to provide a huge variety of products, cheaper than at other stores. Clearly, it occurred to someone within the senior ranks of Walmart that the same approach could be applied to medicine.

In the following article, there is a detailed discussion of both the medical and insurance side of healthcare, as it is being delivered via Walmart. In Israel, with universal healthcare, we easily forget just how difficult, if not horrifying, the experience can be of finding a doctor and getting care. In the US, in an emergency situation, a person may very well find themselves having to cover expenses that easily range in the many thousands of dollars. For day-to-day care, a person may find that their doctor has suddenly changed his or her association with a particular health plan, and thus is no longer accessible (unless the patient is willing to go privately). The stability of the system we have in Israel, as well as the near complete coverage of medical costs for almost all treatments, provides a level of care that I and my colleagues consider to be from the best in the world.

Walmart, despite not infrequent demonization by various workers’ groups, can be a lifesaver  for  low income individuals in the United States. Walmart already has a large number of retail health clinics spread across its many stores. Walmart is now seeking to replace these clinics with full primary care facilities that also provide evening and weekend care. In addition, Walmart is apparently looking into providing its own form of health insurance that would meet all of the requirements of Obamacare.

Walmart has stressed that their clinics will be a low-cost alternative to traditional options. While traditional clinics may charge hundreds of dollars, if not more, for something as basic as a chest x-ray, Walmart’s ability  to keep prices down should be more than welcome to the public. I have no doubt that someone, somewhere within the traditional medical world will argue that there is some fundamental failing in Walmart’s version of healthcare. While nothing is perfect, I still suspect that the true reason that doctors will challenge Walmart care, will be that it seriously impinges on the income of physicians working in traditional settings.

If technology can help Walmart-based clinics provide faster and better care, you can be sure that Walmart will use whatever software and hardware it needs to. Also, Walmart may very well design and implement its own electronic medical record system, which will be better and faster than whatever is now on the market. Walmart has the resources to reshape significant parts of medicine, and still provide it all at a low cost.

Walmart will be able to provide a one-stop shop for many things. The physician in the on-site clinic will write a prescription that will be available for purchase at the on-site pharmacy. Over-the-counter medications will be available in the regular aisles. It might very well be that Walmart will be able to achieve even further discounts in the cost of medical treatments and medications by virtue of volume. And, as I noted above, if Walmart soon offers its own insurance to the general public, this will likely be simpler to understand and cheaper for the average American. Suffice it to say that if I was a physician in a traditional doctor’s office anywhere near a Walmart, I would become concerned.

As I noted above, a visit to the emergency room for something as simple as a few stitches, can result in a bill for thousands of dollars that must be paid by the patient. And this is even for those people who have insurance and have taken the time to find a hospital which is covered by their insurance plan.There are over 130 million visits each year to hospital emergency rooms in the United States. In many cases, the income from emergency room visits is critical for supporting the hospital’s general costs. If Walmart succeeds in reducing such ER visits by a significant percentage, it could literally lead to severe financial distress for entire hospitals. I cannot say that I feel any remorse for hospitals that would charge thousands of dollars for a few stitches. But the simple fact is that this is not an emotional issue or even one of professionalism. This is a business issue. And in this particular case, the open market approach in the United States can allow for Walmarts, and other equivalent companies, to openly and effectively compete against [ridiculous] hospital charges.

My dream is that the traditional medical services will realize that they cannot be competitive, when they charge very high fees. Also, as more and more medical services openly advertise their menu of services along with the cost of each item, there will be even more pressure on everyone to keep healthcare costs as low as possible.. Once again, there will be those in the traditional medical world who will argue that, for various reasons, low-cost medicine is not sustainable. They will argue that doctors cannot financially thrive, and cover even their medical school  loans, for the salaries that are being offered in a post Walmart era. While this may be true, it simply is not the issue right now. The same market forces that will allow for Walmart to stitch a child for $100 rather than $5000, will find a solution for employing sufficient doctors to staff all of Walmart clinics.

I have read countless times about doctors’ frustration over not being able to develop a doctor-patient relationship due to various constraints. I hope that all of these changes that are happening on the American medical front, will allow for every person in the United States to get healthcare at a price that is as low as possible. It is impossible to create a doctor-patient relationship, if the patient has no access to a doctor because of cost or insurance rules. Perhaps Walmart or companies like it, or even the traditional model of healthcare, will finally provide universal access as well as professional and caring healthcare providers.. The benefits are clear. I can only hope that such a reality will occur in the very near future.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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